MSF works out of two health facilities in the Kurram district of Pakistan’s Federally Administered Tribal Areas (FATA) region, which has been plagued by militancy over the past decade and was the location of many U.S. drone strikes targeting commanders from al Qaeda and other militant groups.

Though security has improved in FATA in recent years, sectarian militant attacks, primarily targeting Shi‘ite Muslims, still occur. Twin blasts in the Kurram’s most populous town, Parachinar killed more than 75 people in June.

Local officials say MSF provides essential healthcare facilities in FATA, an area with some of Pakistan’s poorest healthcare and lowest literacy rates.

“We have been asked to close our medical activities in Kurram Agency,” MSF said in a statement to the media, adding that Pakistan had refused to issue a No Objection Certificate (NOC) for the charity to work in the tribal areas.

“MSF is saddened by the decision from the authorities responsible for NGOs working in Kurram Agency. The closure brings to and end 14 years of MSF working with the FATA Health Services in Kurram Agency,” country representative Catherine Moody said in the statement.

Foreign nationals and organizations working in Pakistan require NOCs to operate in certain areas. Pakistani NGOs and journalists also face restrictions when working in the tribal areas.

“MSF provides diagnosis and treatment facilities to the community for Leishmaniasis, immunisation for children, as well ... responding to emergencies, disease outbreaks and mass casualties,” the organisation said.

The region’s health directorate did not respond to requests for comment but Dr. Mohammad Ishaq, who works there, said MSF was asked to leave because they did not have a valid NOC.

“I personally think MSF was doing a great job for the patients in FATA,” he said, adding that he did not know why its licence to work there was revoked.

“We have been working in FATA since 2004. We were never denied an NOC in‎ the past. This will affect many patients in the area,” one MSF employee said, asking not to be identified.

He added that the organization had 70 staff members working at the two health facilities.

The official who notified MSF that their operations would need to be shut down added: “I did what I was directed to by my bosses in Peshawar but really don’t know the reason behind MSF being stopped.”